POS0241 JAK INHIBITORS IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: EXPLORING EARLY RESPONSE ON CENTRAL SENSITIZATION AND CATASTROPHISM SYMPTOMS
Authors: F. Salaffi, M. DI Carlo, M. Carotti, L. Ceccarelli, S. Fulginei, S. Farah, A. Giovagnoni
Journal: Annals of the Rheumatic Diseases (2022)

Background Catastrophizing has been demonstrated to be linked with central sensitization (CS), although few studies have investigated the potential of interactions between catastrophizing and CS in patients receiving JAK inhibitors. Objectives To explore the link between changes in Simplified Disease Activity Index (SDAI) and changes in pain catastrophizing, pain intensity, neuropathic pain component (NPC) and CS symptoms that occur with the introduction of a novel treatment targeting the JAK/STAT signalling pathway. Methods 115 patients in an ongoing prospective observational analysis filled out questionnaires at the start and conclusion of the research, using the Pain Catastrophizing Scale (PCS) and Central Sensitization Inventory (CSI). The study included 22 patients on tofacitinib monotherapy (5 mg BD), 19 on tofacitinib and MTX, 19 on baricitinib monotherapy (4 mg OD), 14 on baricitinib and MTX, 17 on upadacitinib monotherapy (15 mg OD), 16 on upadacitinib and MTX, and 8 on filgotinib (200mg OD) and MTX. The disease activity index was evaluated by the simplified disease activity index (SDAI). The US scoring system validated in the US-CLARA was used. The Semantic Questionnaire for Rheumatology (SQR) and PainDETECT questionnaire (PDQ), were used to assess pain severity and NPC. Using multivariable linear regression models, we investigated the connection between changes in SDAI and in CSI, PCS, PDQ, SQR and US score. Results At baseline, the percentage of RA patients who exceeded the thresholds for the presence of NPC (PDQ &gt; 19 points) of the CSI (&gt; 40 points) and PCS (&gt; 30 points) were 43.5%, 36.5%, and 62.6%, respectively. After 4 weeks of treatment, the patient-reported scores and the disease composite index decreased significantly, SRQ (p&lt;0.0001), PDQ (p=0.0084), PCS (p=0.0066), CSI (p=0.0165) and SDAI (p&lt;0.0001).The US score did not change significantly (5.25 to 5.03; p=0.248). SDAI achieved 10.6% remission and 15.2% low disease activity at week 4. Multivariate regression analysis indicated that changes in SDAI were exclusively connected to changes in catastrophizing (coefficient=0.500, P=0.0224). Conclusion After starting a Jak inhibitor, pain catastrophizing, but not articular inflammation on US, diminishes along with disease activity. These findings provide credence to the concept of catastrophizing as a dynamic construct that may be adjusted by therapy aimed at reducing inflammatory disease activity and pain levels in the RA patient. References [1] Hammer HB, et al. Pain catastrophizing, subjective outcomes, and inflammatory assessments including ultrasound: results from a longitudinal study of rheumatoid arthritis patients. Arthritis Care Res 2018;70:703–12 [2] Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15 Table 1. Multivariate regression analysis, using SDAI (Simplified Disease Activity Index) changes as dependent variable. Independent variables Coefficient Std. Error T P (Constant ) -0.7239 ACPA, titre -0.0002410 0.002528 -0.0953 0.9242 Age, yrs -0.09063 0.1028 -0.881 0.3803 BMI -0.1600 0.2787 -0.574 0.5671 Disease duration, yrs -0.1003 0.1611 -0.623 0.5347 Educational level, yrs -0.1072 0.3703 -0.289 0.7728 Diff. CSI 0.3194 0.1984 1.610 0.1105 Diff. SRQ 0.07018 0.3726 0.188 0.8509 Diff US score 1.2248 0.7024 1.744 0.0842 Diff PCS 0.5009 0.2160 2.318 0.0224 Diff PDQ 0.1860 0.2271 0.819 0.4146 Abbreviations: ACPA= Anti-Citrullinated Protein/peptide Antibody; BMI= Body Mass Index; CSI= Central Sensitization Inventory; SRQ= Semantic Questionnaire for Rheumatology; US= Ultrasonography; PCS= Pain Catastrophizing Scale; PDQ= PainDETECT Questionnaire. Disclosure of Interests None declared